The Prevalence of Heart Failure and Challenges in its Management

James Januzzi, MD: Hello and welcome to this HCPLive® Peer Exchange titled “Emerging Evidence to Guide Patient-Centric Treatment Selection for Heart Failure.” I am James Januzzi, clinical cardiologist at Massachusetts General Hospital and from the Baim Institute for Clinical Research and professor of Medicine at Harvard Medical School in Boston, Massachusetts. Joining me today in this discussion are 3 of my valued colleagues. Dr Robert Mentz is an associate professor of medicine and chief of the Heart Failure Section at Duke University in Durham, North Carolina. Dr Javed Butler is president at Baylor Scott and White Health in Dallas, Texas, and a professor of medicine at the University of Mississippi, in Jackson, Mississippi. Dr Muthiah Vaduganathan is a cardiologist and co-director at the Center for Cardiometabolic Implementation at the Brigham and Women’s Hospital, and faculty at the Harvard Medical School in Boston, Massachusetts. Our conversation today will focus on new evidence to guide personalized care in heart failure, and we will discuss updates in the most recent heart failure trials just available now. Why don’t we get started. I’m going to turn to Dr Butler for the first question which is that, heart failure carries a high clinical, societal and economic burden. It’s awful for our patients, and it’s awful for the hospital system, it’s a terrible diagnosis. What can we expect in the future? What do we know about the current prevalence of heart failure and where we are heading about the future prevalence of heart failure?

Javed Butler, MD, MPH, MBA: This is an important question, and I like the way you have framed the question that there’s clinical implications, then the patient and the caregiver implications, and then the societal implications in terms of cost as well. If you look at some of the latest figures, there are about 56 million individuals around the globe that have heart failure diagnosis. If you look at the prevalence figures from US it’s about 7.5 million with comparable figures from Europe. One issue is that the prevalence projections are pretty dire that these things are going to get worse. But the good news is that now we are diagnosing and thinking about diagnosing heart failure a little bit more accurately, a little more carefully especially HFpEF [heart failure with preserved ejection fraction]. The figures that I gave likely are underrepresentation, because we don’t screen just like we screen for some of the other diseases, we don’t screen for heart failure, but I think that will change. The projections are that with the aging of the population, all of the major chronic cardiovascular comorbidities will increase, but the proportional increase projected is highest for heart failure. It’s projected about 25% increase by 2030.

James Januzzi, MD: That’s really sobering, especially to the extent that there’s a limited number of heart failure physicians available. Rob, as the director of heart failure at Duke, how do you message this to non-heart failure specialists?

Robert J. Mentz, MD: This is a really important piece Jim, as we think about how do we best care for our patients with heart failure, realizing this is a broad community, it’s a multidisciplinary team. The vast majority of patients living with heart failure are going to be managed by their general practitioner, the nurse clinicians they may work with them and working together to identify those higher risk patients to see who can we get in with a heart failure clinician to really make sure we’re optimizing their care in their clinical course.

James Januzzi, MD: Rob, what are the challenges that we face in terms of managing heart failure in the United States relative to the burden of hospitalization, admissions, readmissions, etcetera?

Robert J. Mentz, MD: As Javed nicely summarized it is the prevalence continues to increase. We know the burden on our patients for coming into the hospital with worsening signs and symptoms, needing to get the fluid off and get them on the right therapies. Some of the numbers are staggering, more than 1 million hospitalizations for heart failure in the US alone. Then once patients are coming into the hospital, that re-admission rate is so high 20%, 30%, 40% within months of that first hospitalization, knowing that each hospitalization is associated with worse quality of life, and increased risk for morbidity and mortality following that.

James Januzzi, MD: That’s obviously really sobering, and it has called attention to the fact that heart failure is not just a problem of heart failure specialists it’s really all hands on deck at this point, because as you say, with each hospitalization, there’s an impact on health status, quality of life and functioning, mortality and morbidity.

Transcript edited for clarity